Gender Inclusion in Cancer Care: Identity Versus Expression

By Stephanie DeMeyer, MA, Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - Last Updated: August 4, 2022


To provide gender-affirming care, oncology nurses need more education about the needs of sexual and gender minorities. Often, they have not been taught basic terminology for patient-centered communication. Even using terms such as “women’s health” can be non-inclusive. As more information surfaces with evidence-based practice guidelines, oncology nurses will need lifelong learning.


Explore Your Own Beliefs

The American Nurses Association “condemns discrimination based on sexual orientation, gender identity, and/or expression in healthcare.” Unfortunately, biases among nurses and other healthcare professionals toward LGBTQIA+ patients are common. These biases may be explicit, where the person is aware of the prejudices and attitudes, or implicit, in which the biases are unconscious and automatic.

Oncology nurses must explore their own beliefs on gender and gender identity to help uncover implicit bias. Take a moment to reflect on these questions:

  1. How will your beliefs and your background affect your care of patients with cancer, or at risk for cancer, who are gender diverse and gender nonconforming?
  2. Do you or your colleagues have a negative attitude toward people and certain gender stereotypes, whether they are conscious or unconscious?

Educate Yourself

The Association of Community Cancer Centers (ACCC) published an article to fill the knowledge gap across the cancer care continuum, titled “Cancer Care Considerations for Sexual and Gender Minority Patients.” They note that “lack of knowledge among healthcare professionals regarding the degree of stigma, bias, and unique challenges faced by sexual and gender minorities impacts all aspects of cancer care.”

To advocate for LGBTQIA+ patients and their specific needs, nurses must understand some basic terminology.

  • Sex assigned at birth sometimes may be called “gender assignment.” It refers to the label a medical professional gives to a newborn based on the external anatomy of male, female, or intersex.
  • Gender identity is a person’s internal sense of being male, female, or something else. Examples of non-male/female include agender, binary, gender fluid, gender nonconforming, genderqueer, or nonbinary.
  • Gender expression is how a person represents or expresses one’s gender identity to others, often through behavior, clothing, hairstyles, voice, or body characteristics. Expression can be masculine, feminine, neutral, or other.

The core of who a person is, and how they present themselves, is gender identity and gender expression. Gender identity may be the same or different from their birth-assigned sex. It is internal and not always visible. Gender expression is visible; it is how they choose to present their gender.

Be Sure to Ask

Gender identity and gender expression do not always correlate with one another. They may or may not match traditional masculine and feminine images. Therefore, oncology nurses must not assume a patient’s gender identity based on how they speak, dress, or act—it is important to ask. For example, many organizations are changing intake forms to include pronouns and how a person identifies race/ethnicity, sexual orientation, and gender identity. If your organization does not ask about pronouns, you can ask the patient during your initial encounter.

As the ACCC emphasizes, “sexual and gender minority patients need and deserve patient-centered care.” Cancer care is making great strides to be more inclusive. Oncology nurses are in a key position to reduce the adverse effects of bias and develop effective strategies for inclusion. Help lead the way to health equity.


ANA Position Statement: Nursing Advocacy for LGBTQ+ Populations

Post Tags:Health Equity